One of the biggest dilemmas athletes face is how to identify an injury, care for it properly, and return to former performance levels quickly. The way we handle the setback determines the downtime duration, our fitness upon return, and the likelihood of experiencing the same injury in the future. Let’s decipher the injury puzzle step by step.

What Is an Injury?

Injuries aren’t always painful, though they are always damaging and inhibit our ability to ‘play.’ We commonly envision soft tissue or bone injuries such as stress fractures, tendonitis, or muscle tears. However, there are injuries that X-rays and MRIs cannot confirm: chronic fatigue, the flu, blood disorders, and hormone-related issues that disrupt our capability to train and race. They often go untreated for long periods of time because we can still run.

How Do I Know I’m Injured?

Ironically, experience comes in handy. The more you’ve been injured, the easier it’ll be to recognize. For those who are new to running, have avoided injury, or repeatedly fail to recognize new injuries, here are three guidelines to use when determining if an injury has occurred or is imminent:

1. The act of running should not be a painful activity.A healthy body’s feet, hamstrings, knees, back, and so on should not hurt when jogging down the block. If they do, then you have a deficiency that needs to be addressed.

2. Understand the difference between adaptive and restrictive damage.Adaptive damage is beneficial. This is the ‘good’ pain we associate with running. It occurs when we speed up, increase our effort, or charge up or down a hill. Our lungs and legs burn and, as a result, we experience delayed onset muscle soreness and fatigue following the workout. This is how our body absorbs and adapts to tough training in order to reduce further damage in subsequent workouts.

Restrictive damage isn’t good. This is an injury. Watch for impairments to your running gait, swelling, discoloration, persistent or asymmetrical soreness, aching, sharp pain, constant fatigue, abnormally high heart rate, loss of appetite, and lack of power. These are not symptoms to ignore and simply ‘run through.’ The body can’t efficiently or appropriately remedy this type of damage without outside assistance.

3. Running shouldn’t negatively affect the other aspects of your life.Of course, when we’re in the meat of a training cycle, fatigue is always a factor. However, this weariness shouldn’t disrupt your relationship with family and friends, impair work productivity and performance, or leave you under the weather.

I’m Injured, Now What?

Okay, something isn’t quite right, but how do you make a quick return to issue-free training?

Acknowledging the presence of a problem is the most important step in the recovery process. Cease the activity or level of activity that causes the abnormal symptoms. Continuing to train with an injury can lead to greater harm and a longer rehabilitation time.

Do not self-diagnose. Not all information sources (anecdotal or Internet-based) are accurate when determining injuries or their treatments.

Seek the assistance of a specialist. Understandably, this can be a scary proposition due to cost or what treatment might entail. However, if you find an expert who is an athlete and comes recommended by the running community, most common running injuries, if caught early enough, won’t require an expensive work-up and much of the treatment can be done on your own.

What Does Treatment Require?

It’s improbable that you’ll walk out of the doctor’s office miraculously cured after the first visit. Be prepared for the recovery to be lengthy and more emotionally arduous than the training you were doing beforehand. Dr. A.J. Gregg, a certified strength and conditioning specialist at HYPO2 High Performance Sports Center in Flagstaff, Arizona, explains, “There are many factors that are likely to influence our return to sport. Individual psychological responses, age, lifestyle, and work commitments all impact recovery rates. Some of these factors we can manipulate and others we cannot.” Here are some pointers that the pros use to help their patients through the recovery process:

1. Be patient and maintain an optimistic outlook.Like any cut, scrape, or bruise, an injury will take time to heal. The successful athlete will accept this truth and be less likely to rush, thus hindering the recovery process. Gregg points to a published review of the psychological factors associated with returning to sport after an athletic injury and he summarizes, “The study found that athletes who had a positive emotional reaction to their injury and the ensuing recovery had a greater chance of returning to their previous level of fitness faster.”

2. Stay as active as possible.“Once you’re injured there is rarely a need to completely stop training,” says Jeff Waldberg, physical therapist and owner of Los Angeles, California-based Ortho Pro Physical Therapy and The Runner’s Clinic. “Find a comfortable cross-training regimen. In addition, use ice/heat or other home modalities such as stretching or foam rolling to help the injuries heal in less time.”

Once you’re cleared to begin working out, your cross-training matrix should mimic, as closely as possible, the movement and impact of running. Be sure to remain pain-free and within the effort ranges prescribed by your therapist or coach. In order of preference, here are the some of the best tools available:

Continue to reproduce your running routine in terms of time, intensity, and frequency with the optimal piece of equipment. Maintaining your aerobic fitness in this way will ensure that the transition back to running is easier and will produce mood-enhancing endorphins while you’re rehabbing your injury.

3. Make gait modifications.If running is the root cause of your injury then address your form. Dr. Gregg explains, “There are justifications for altering our gait. These changes address specific flaws in our form, allow tissues to adapt to new stresses, adjust pressure to irritated areas, and breaks the pain cycle through variety and graded exposure.” Waldberg agrees, “Videotape your running and have it analyzed by a ‘movement expert.’ Once form is corrected the vast majority of running injuries resolve.”

Both Gregg and Waldberg focus on several form traits during their examinations.

Overstriding“Be conscious of where your foot lands in relation to your body,” says Gregg. “You don’t want your foot landing way out in front of you or your knee straight or locked upon impact. Work on feeling like your foot is landing behind you.”

CadenceWaldberg says, “Once I work with a runner to quicken their cadence most pains subside and efficiency returns.” Count how many times one foot hits the ground in 30 seconds. It should be about 45 times. Waldberg, who’s analyzed the form of more than 3,000 runners, has discovered that anything less than this will inevitably lead to form mistakes and injury.

Glute activationThe posterior chain (glute, hamstring, back, calves) is the powerhouse of your running. Gregg suggests this exercise while teaching your rear to engage, “Tighten your butt when your foot hits the ground and feel that you are pulling your leg backwards while it is on the ground. Complete this ‘paw back’ motion for 30 to 60 seconds every half-mile. This helps eliminate overstriding by increasing hip extension, decreases how much the pelvis drops side to side, and reduces the amount of knee collapse that occurs during ground contact.”

Run softlyListen to the sounds you make when you run. Eliminate any pounding or slapping upon impact. Imagine that the earth you’re running on is very hot. Play with your own form to discover the best way to land quietly.

Foot strikeGregg suggests, “If you are having trouble with your calves or your metatarsals try to run with a light heel strike for 30 to 60 seconds every three minutes. If you have knee and hip pain shift to a forefoot or mid-foot strike for 30 seconds every three minutes. If you see improvement then extend these time periods.”

How Do I Know When I Can Start Running Again?

Injury-related hiatuses have no predetermined recovery timelines. One must ease back into running once the injury subsides. “Spontaneity is not a good rule to follow when recovering from an injury,” states Waldberg. “The body must slowly return to its optimal pre-injury condition. An injury at 85% of normal may ‘feel’ 100% to the anxious sidelined runner, but it is still vulnerable to re-injury. Each run must be planned in terms of its intensity, duration, distance, elevation, and footwear.”

Dr. Gregg suggests this ‘return to play’ prescription:

Begin by walking for 45 minutes without difficulty.

Once you can do this, then run a mile on a soft, flat surface.

If there are no ill effects, then the next day run two miles.

Progress a mile/day, up to five miles.

Add hills.

Include some faster running.

Run with others.

Add pavement.

Finally, if you have done all of the above issue-free, you can compete again.

Gregg also cautions, “If you have an injury on one side of the body, don’t train fully until the injured side is as strong, mobile, stable, and quick as its healthy opposite.”

What Do I Do If I’m Continuously Sidelined?

Injury rehabilitation reduces valuable training time therefore your primary goal should be to remain uninjured. In order to facilitate this, Walberg and Gregg recommend the following pre-hab protocol:

Flexibility – Active isolated stretching, the act of contracting one muscle to allow the opposing muscle to relax and lengthen. This increases range of motion and promotes circulation.

Footwear – Check the wear and tear on your shoes. Experiment with different shoe weights, heel-to-toe drops, cushioning, and flexibility.

Diet – Proper nutrition is the primary building block of our health. Without it our ability to train, perform, and recover crumbles.

“Running will always require more than simply just running,” says Gregg. “The ancillary routines, bodily maintenance, and good eating habits must always continue so you remain healthy.”

“Sometimes an injury can be the worst best thing that could have happened,” concludes Gregg. Don’t view an injury as a setback, but rather as a learning opportunity. Use the recovery time to strengthen weaknesses, uncover training mistakes, and determine your limits. You’ll come out on the other side a smarter athlete and less likely to fall into the same injury pattern.

Ian Torrence has completed 163 ultras, with 50 wins. Ian works as an online coach at McMillan Running. Information about his ultramarathon coaching services can be found at McMillanrunning.com. You can also catch up with Ian at his blog.

Fantastic article on injury, in general. I am a sports-med focused podiatrist and trail runner and I have already given this article out to multiple patients. It is comprehensive in addressing the psychology of injury which includes acceptance and recognition. As a practitioner, I don't focus on 'NO' I focus on alternate activity and the fact that this injury can be a teacher. Look closely at your biomechanic and physiologic weaknesses. Address them, work on them, take the time and effort you once put into training to correct these flaws that may contribute to future injury. As competitors we visualize on success, improvements, training. We are good at training in 'the now' but not as good at living 'in the now' when we are injured. The visualization should focus from races and training to our own weaknesses and how to improve them. And then, when we are better, to a SLOW progression to full training and competition. Cheers, fantastic article!

Could someone comment on meniscal tears? I had both a lateral and medial meniscectomy 14 weeks ago. Still some residual swelling and pain with a return to running. I am 57, not getting any younger. Told by both the physician and PT to wait longer. If anyone has any inspirational stories, I am ready to hear them. All race goals on hold at this time…

Hello! I just posted an entry referencing my meniscal tear. To give a little more info, it was not a 'good' tear as my surgeon described. It was very close to the root but they did repair it. That was about 6 weeks ago, however, the more serious issue is related to cartiledge detachment and deterioration. I've spent this time easing back into run, actually no road running at all, just walking. Trail running 2-3 times a week, PT 1-2x/week and strength training 3-5x/week (mostly the exercises I do at PT but some weights in the gym also). I've also increased treadmill running with the incline at 10% or more which forces me to go very slow but provides a great workout. I'm very happy to be able to do about 2 hours without knee pay (very slow and walking down hills) on the trail compared to 3 months ago not being able to do more than 20 minutes without significant pain. I'm 43, thinking I'm 23 and paying the price. Good luck to a speedy recovery!

Great article Ian! I was late in accepting #1 & 2 from recognizing a knee injury last fall while increasing my training volume and intensity. While I did back off somewhat, I continued to come back and train harder; exactly what I should not have done. Eventually, after increased pain and misery, I finally saw an excellent sports orthopedic and found out I had a torn meniscus and detached cartilage. After surgery in Feb, I'm well on my way to recovery and happy to report I can do up to 2 hours of pain free trail running in the AZ desert. It's good to see I'm following nearly all the advice in the article and progressing both physically and mentally.